Author(s)

Thomas Vedtofte¹, Gitte Vedel Melsen¹, Lise Bathum^1,2, Christina Ellervik^1,3, Maja Jørgensen¹

¹Department of Clinical Biochemistry, Slagelse-Naestved Hospital, Naestved, Denmark.
²Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
³Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.

Introduction: The need for anticoagulation therapy increases with age, mainly due to the increased prevalence of atrial fibrillation. Time in therapeutic range (TTR) is a marker of the quality of the therapy as TTR is inversely correlated with adverse reactions. We developed a bioanalyst-led management program for control of warfarin treatment in elderly disabled patients in their own home and maintain a high TTR. Material and Methods: Residents in nursing home settings were included. Visiting nurses measured INR with a point of care testing device. If INR was within Therapeutic Range (TR), the nurse dosed warfarin unaltered. If INR was out of TR, the visiting nurse contacted a specially trained bioanalyst by phone. An explanation was sought, and a new dosage plan was made. Results: A total of 579 patients were included; 356 females (61%). Mean age was 79.6 years. Approximately 10% were residents in nursing home settings and the rest in domiciliary care. TTR was 72%. The subtherapeutic values were 15% and supratherapeutic values 13%. In total, 139 patients died during the study period. Ten deaths could be related to possible side effects of warfarin treatment. Conclusions: Our results indicate that a bioanalyst-led program is able to simplify anticoagulation monitoring, while maintaining INR control similar to a specialized clinic. Furthermore, we avoided hospitalizations when INR was unacceptably high by treating the patient with oral vitamin-K at home. Our findings could be helpful when planning warfarin treatment in elderly, fragile patients.

Warfarin, INR, Time in Therapeutic Range, Elderly, Nursery Care Setting

Vedtofte, T. , Melsen, G. , Bathum, L. , Ellervik, C. and Jørgensen, M. (2014) Elderly Disabled Patients in Oral Anticoagulation Treatment: An Evaluation of a Bioanalyst-Led Management Program Reaching an Average of 72% of Time in Therapeutic Range. World Journal of Cardiovascular Diseases, 4, 623-630. doi: 10.4236/wjcd.2014.412074.